Argintar Evan, Heckmann Nathanael, Wang Lawrence, Tibone James E, Lee Thay Q
Department of Orthopaedic Surgery, The University of Southern California, Los Angeles, CA, USA.
Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System (09/151), 5901 East 7th. Street, Long Beach, CA, 90822, USA.
Knee Surg Sports Traumatol Arthrosc. 2016 Feb;24(2):585-92. doi: 10.1007/s00167-014-3092-4. Epub 2014 Jun 10.
The purpose of this study was to determine the biomechanical effects of the remplissage repair combined with Bankart repair for engaging Hill-Sachs lesions on range of motion (ROM), translation, and glenohumeral kinematics.
Six cadaveric shoulders were tested using a custom shoulder testing system. ROM, kinematics, and anterior-posterior (AP) and superior-inferior glenohumeral translations were quantified at 0° and 60° glenohumeral abduction. Six conditions were tested: intact, Bankart lesion, Bankart with 40 % Hill-Sachs lesion, Bankart repair, Bankart repair with remplissage, and remplissage repair alone.
Humeral external rotation (ER) and total range of motion increased significantly after the creation of the Bankart lesion at both 0° and 60° abduction. The Bankart repair restored ER to intact values at 0° and 60° abduction, and the addition of the remplissage repair did not significantly alter range of motion from the Bankart repair alone. AP translation increased following the creation of the Bankart and Hill-Sachs lesions and was restored with the Bankart repair; the remplissage did not alter translation from the Bankart repair alone. At maximum ER at 60° abduction, the apex of the humeral head shifted posteriorly and inferiorly with remplissage repair.
The addition of the remplissage procedure combined with Bankart repair for treatment of large Hill-Sachs lesions had no statistically significant effect on ROM or translation, but altered the kinematics of the glenohumeral joint. Thus, by addressing the humeral bone defect following an anterior shoulder dislocation, the remplissage technique with concurrent Bankart repair may be a relatively minimally invasive option for converting engaging Hill-Sachs lesions to non-engaging and promoting shoulder stability, though further biomechanical and clinical studies are warranted.
本研究的目的是确定用于治疗Hill-Sachs损伤的充填修复联合Bankart修复对活动范围（ROM）、平移和盂肱关节运动学的生物力学影响。
使用定制的肩部测试系统对六个尸体肩部进行测试。在盂肱关节外展0°和60°时，对ROM、运动学以及前后（AP）和上下盂肱关节平移进行量化。测试了六种情况：完整、Bankart损伤、伴有40% Hill-Sachs损伤的Bankart损伤、Bankart修复、Bankart修复联合充填修复以及单纯充填修复。
在0°和60°外展时，Bankart损伤形成后，肱骨外旋（ER）和总活动范围显著增加。Bankart修复在0°和60°外展时将ER恢复到完整值，添加充填修复后与单纯Bankart修复相比，活动范围没有显著改变。Bankart和Hill-Sachs损伤形成后，AP平移增加，Bankart修复可使其恢复；充填修复与单纯Bankart修复相比，未改变平移。在60°外展最大ER时，充填修复后肱骨头顶点向后下方移位。
对于大的Hill-Sachs损伤，充填修复联合Bankart修复对ROM或平移没有统计学上的显著影响，但改变了盂肱关节的运动学。因此，通过解决前肩脱位后的肱骨骨缺损问题，同时进行Bankart修复的充填技术可能是将嵌入性Hill-Sachs损伤转变为非嵌入性并促进肩部稳定性的一种相对微创的选择，不过仍需要进一步的生物力学和临床研究。
